CBT-E following discontinued FBT for adolescents with eating disorders: time for a more individual approach?

Family-based treatment (FBT) has proven efficacy among adolescents with eating disorders (ED). However, it is not effective or suitable for all young people and their families, which makes alternative treatments important. This is the first pilot study to compare the relative effectiveness of manualised enhanced cognitive behaviour therapy (CBT-E) among a transdiagnostic eating disorder sample of adolescents for whom CBT-E was their first ED treatment (n=42), and a group who had previously started FBT which had been discontinued without full recovery (n=27). Participants (n=69) aged 13-17 with an eating disorder completed manualised CBT-E. Outcome measures included body mass index (BMI) centile, ED psychopathology and clinical impairment. Across the cohort, results showed improvements across ED psychopathology, clinical impairment and BMI centile. The effect of the intervention on ED psychopathology and clinical impairment did not vary between groups, nor did attrition rates. There was a difference between the groups on BMI centile, with those who had previously been treated with FBT showing no change in BMI centile, whereas those with no previous FBT increased BMI at post-treatment. Implications from this research suggest that CBT-E is a viable promising alternative and could be offered among those for whom FBT has not achieved full recovery.Key learning aims Delivering CBT-E to adolescents with eating disorders who have previously engaged in FBT but have not achieved full recovery is a promising subsequent treatment option. CBT-E was similarly completed and displayed similar overall group reductions in eating disorder symptoms in those who had discontinued FBT without full recovery compared with those who had not previously engaged with FBT. Results suggest that CBT-E could be offered when FBT has not achieved full recovery, although more research is required to understand optimal timings of treatment transition in such instances.